This Week in Washington: Senate Finance Committee chairman sends letters concerning MA marketing practices; Senate Committee on Aging holds hearing on assisted living facilities; CMS requests information on MA prior authorization, beneficiary access and benefits data; Administration touts marketplace enrollment.

Congress

House

House Members Send Letter Concerning Tianeptine

On Jan. 18, Rep. Jackson (D-NC) led Reps. McCormick (R-GA), Rose (R-TN), Boebert (R-CO) and Nickel (D-NC) in sending a letter to Food and Drug Administration (FDA) Commissioner Robert Califf, requesting information on the actions the FDA has taken to address the use of tianeptine.

Tianeptine is an opioid-like antidepressant that has not been approved for medical use and has been shown to be extremely addictive. The FDA recently warned consumers of purchasing and using tianeptine products after it received reports of adverse effects linked to their use, including seizures and hospitalizations.

For more information, click here.

Forty-Six Representatives Send Letter Concerning Surveillance Colonoscopies

On Jan. 10, Rep. Dingell (D-MI) led 45 representatives in sending a letter to Department of Health and Human Services (HHS) Secretary Xavier Becerra, urging HHS to expand access to preventative care by requiring insurers to cover surveillance colonoscopies without cost-sharing.

The members are requesting that HHS clarify in its federal frequently asked question guidance for insurers regulated by the Affordable Care Act, that follow-up surveillance colonoscopies should be treated as a preventive service. Insurers currently treat an additional colonoscopy screening as a diagnostic service.

For more information, click here.

Rep. Underwood Renews Push to Make ACA Tax Credits Permanent

On Jan. 24, Rep. Underwood (D-IL) renewed her push to make the enhanced tax credits of the American Care Act (ACA) permanent and announced that she is looking at legislative vehicles through which this could be accomplished. ACA tax credits were originally set to expire in 2023 but were extended through 2025 by the Inflation Reduction Act.

House Committee on Education and the Workforce Seeks to Strengthen ERISA

On Jan. 22, House Committee on Education and the Workforce Chairman Virginia Foxx (R-NC) led the committee in sending a letter to employer health benefit stakeholders, requesting they provide feedback on how to strengthen and clarify Employee Retirement Income Security Act preemption.

The committee, which has jurisdiction over employer-sponsored health coverage, is seeking information concerning transparency, portability, data sharing, quality measures, fiduciary obligations, high-cost specialty drugs and Health Insurance Portability and Accountability Act protections.

For more information, click here.

Senate

Senate Finance Committee Chairman and Ranking Member Release White Paper on Mitigating Generic Drug Shortages

On Jan. 25, Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) released a white paper outlining legislative proposals they may incorporate into legislation to reform the Medicare and Medicaid programs to prevent generic drug shortages. The Finance Committee is considering reforming Medicare payment for generic sterile injectables and implementing incentives for hospitals and pharmacies to engage in shortage prevention and mitigation activities.

The committee is also considering reforming the Medicare Drug Rebate Program and implementing new Part D pilot programs to encourage pharmacies to purchase generic medicines.

For more information, click here.

Senate Finance Committee Chairman Sends Letters Concerning MA Marketing Practices

On Jan. 23, Senate Finance Committee Chairman Ron Wyden (D-OR) sent letters to Medicare Advantage (MA) third-party marketing organizations (TPMOs) eHealth, GoHealth, Agent Pipeline, SelectQuote and TRANZACT, seeking information on how they use insurance agents, lead generators and other data to target, market to and direct seniors towards certain MA plans.

The chairman is concerned that TPMOs are using misleading information to sell Medicare plans and are selling seniors’ personal data to lead generators. Last year, the chairman urged the Centers for Medicare and Medicaid Services to implement stronger marketing rules and the committee held a hearing to evaluate the MA enrollment period and marketing rule developments.

For more information, click here.

Senators Send Letter Concerning FTC Investigation of PBM Business Practices

On Jan. 22, Sens. Grassley (R-IA) and Cantwell (D-WA) led 12 senators in sending a letter to Federal Trade Commission (FTC) Chair Lina Khan, requesting that the FTC complete its investigation of pharmacy benefit manager (PBM) business practices and publicly release a progress report on the status of its investigation.

The FTC launched an inquiry into PBM business practices in June 2023 and has been investigating the impact that vertically integrated PBMs have on the access and affordability of prescription drugs.

For more information, click here.

Senate Committee on Aging Holds Hearing on Assisted Living Facilities

On Jan. 25, the Senate Committee on Aging held a hearing on assisted living facilities and discussed how assisted living care could be expanded and strengthened. Witnesses included:

  • Patricia “Patty” Vessenmeyer, Advocate
  • Jennifer Craft Morgan, Director and Professor at the Georgia State University Gerontology Institute
  • Julie Simpkins, Co-President of Gardant Management Solutions
  • Richard Mollot, Executive Director of the Long Term Care Community Coalition

For more information, click here.

Telemental Health Care Access Act Reintroduced

On Jan. 24, Senate Health, Education, Labor and Pensions Committee Ranking Member Bill Cassidy (R-LA) and Sens. Smith (D-MN), Thune (R-SD) and Cardin (D-MD) reintroduced the Telemental Health Care Access Act. The legislation would remove the statutory requirement that Medicare beneficiaries be seen in person within six months of being treated for mental health services through telehealth.

For more information, click here.

Medicare Transaction Fraud Prevention Act Introduced

On Jan. 24, Senate Health, Education, Labor and Pensions Committee Ranking Member Bill Cassidy (R-LA) and Sen. Braun (R-IN) introduced the Medicare Transaction Fraud Prevention Act. The legislation would direct the Centers for Medicare and Medicaid Services to establish a two-year pilot period to oversee Medicare-covered purchasing of durable medical equipment and other diagnostic testing related products.

A companion bill was introduced in the House by Rep. Schweikert (R-AZ).

For more information, click here.

MedPAC and MACPAC Release 2024 Data Book on Dually Eligible Beneficiaries

On Jan. 22, the Medicare Payment Advisory Commission and the Medicaid and Children’s Health Insurance Program Payment and Access Commission jointly released the 2024 data book for beneficiaries dually eligible for Medicare and Medicaid.

The data book is separated into six sections that focus on the following:

  • Overview of dual-eligible beneficiaries;
  • Characteristics of dual-eligible beneficiaries;
  • Eligibility pathways, managed care enrollment and continuity of enrollment;
  • Utilization of and spending on Medicare and Medicaid services for dual-eligible beneficiaries;
  • Medicare and Medicaid spending for dual-eligible beneficiaries by LTSS use; and
  • Trends in dual-eligible population composition, spending and service use.

For more information, click here.

Read more on healthcare policy in McGuireWoods Consulting’s Washington Healthcare Update.